<br/>
<table style='color:#800000;'>
<tr align='right'>
 <td>Business Name: <input type='text' maxlength='32' size='24' name="Your Business Name"/></td>
 <td width='30'>&nbsp;</td>
 <td>Your Name: <input type='text' size='24' name="Your Name"></td>
</tr>
<tr align='right'>
 <td>Your Phone: <input type='text' size='24' name="Your Phone Number"/></td>
 <td width='30'>&nbsp;</td>
 <td>Your e-mail: <input type='text' size='24' name="Your e-mail"/></td>
</tr>
</table>
<br/>
<b>1</b>
<table border="3" style="font-size:7.25pt;background-color:#eaf2ea;">
<tr style='height:20px;'>
 <th>Brand Name</th><th>Manufacture Part Number</th><th>Model Number</th><th>Condition</th><th>Quantity</th><th>Target Price(ea.)</th><th>Substitute</th><th>Time to Search</th>
</tr>
<tr style='height:20px;text-align:center;'>
 <td><input type='text' size='15' name="1Brand Name"/></td>
 <td><input type='text' size='15' name="1Manufacture Part Number"/></td>
 <td><input type='text' size='15' name="1Model Number"/></td>
 <td>
  <select name="1Condition">
   <option>Any</option>
   <option>New</option>
   <option>Refurbished</option>
   <option>Used</option>
  </select>
 </td>
 <td><input type='text' size='6' name="1Quantity"/></td>
 <td><input type='text' size='6' name="1Target Price(ea.)"/></td>
 <td>
 <select name="1Substitute">
  <option/>Yes&nbsp;&nbsp;&nbsp;
  <option/>No
 </select>
 </td>
 <td>
 <select name="1Time to Search">
  <option>Urgent</option>
  <option>1-2 days</option>
  <option>3-4 days</option>
  <option>Week</option>
  <option>Two Weeks</option>
 </select>
 </td>
</tr>
<tr>
 <td colspan='4'><textarea cols='40' rows='2' name="1Description">Description:</textarea></td>
 <td colspan='4'><textarea cols='40' rows='2' name="1Comments">Comments:</textarea></td>
</tr>
</table>
<br/>
<b>2</b>
<table border="3" style="font-size:7.25pt;background-color:#eaf2ea;">
<tr style='height:20px;'>
 <th>Brand Name</th><th>Manufacture Part Number</th><th>Model Number</th><th>Condition</th><th>Quantity</th><th>Target Price(ea.)</th><th>Substitute</th><th>Time to Search</th>
</tr>
<tr style='height:20px;text-align:center;'>
 <td><input type='text' size='15' name="2Brand Name"/></td>
 <td><input type='text' size='15' name="2Manufacture Part Number"/></td>
 <td><input type='text' size='15' name="2Model Number"/></td>
 <td>
 <select name="2Condition">
  <option>Any</option>
  <option>New</option>
  <option>Refurbished</option>
  <option>Used</option>
 </select>
 </td>
 <td><input type='text' size='6' name="2Quantity"/></td>
 <td><input type='text' size='6' name="2Target Price(ea.)"/></td>
 <td>
 <select name="2Substitute">
  <option>Yes&nbsp;&nbsp;&nbsp;</option>
  <option>No</option>
 </select>
 </td>
 <td><select name="2Time to Search">
  <option>Urgent</option>
  <option>1-2 days</option>
  <option>3-4 days</option>
  <option>Week</option>
  <option>Two Weeks</option>
 </select>
 </td>
</tr>
<tr>
 <td colspan='4'><textarea cols='40' rows='2' name="2Description">Description:</textarea></td>
 <td colspan='4'><textarea cols='40' rows='2' name="2Comments">Comments:</textarea></td>
</tr>
</table>
<br/>
